Health care reforms fail to lower hospitalizations in England

Recent health care reforms in England did not lead to the expected outcomes of decreased hospitalisations and specialist visits, according to a new study published this week in PLOS Medicine by James Lopez Bernal from the London School of Hygiene & Tropical Medicine, UK, and colleagues.

The 2012 Health and Social Care Act (HSCA) in England introduced major reforms to the National Health Service (NHS) which gave control of budgets to groups led by general practitioners. One anticipated effect was to shift care away from expensive hospital based care and towards the community. In the new study, the researchers modeled long-term underlying trends in all NHS specialist visits and hospital admissions between 2007 and 2015. As a control, they also examined these trends in Scotland, where reforms did not occur.

The researchers found no significant change in hospital admissions in either England or Scotland. However, in England they found an increase in the trend of outpatient specialist visits following the reforms, leading to a 12.7% higher rate of specialist visits by the end of the study. This is equivalent to about 3.7 million additional specialist visits between 2012 and 2015. No change was seen in specialist visits in Scotland.

"This study alone is unable to determine whether the HSCA can be regarded as a good or bad policy and further research is needed to evaluate other important outcomes such as costs and quality of care," the authors say. "Nevertheless, in the context of similar findings from other large scale health policy experiments, more effort may be needed to target specific costly or poorly evidenced practices (such as tonsillectomy, tympanostomy or antibiotics prescribed for viral infections) rather than count on broad systemwide policy changes that often have unintended consequences."

In an accompanying Perspective, Aziz Sheikh of The University of Edinburgh points out that the new study is a prime example of how researchers can now exploit routinely collected data to quickly and easily evaluate major policy initiatives on the restructuring of health and social care. "As the UK's data assets continue to mature, and following major recent government investments to make routine data more liquid… and developing data science capacity, it will become possible to answer an increasing array of health policy questions within rapid timeframes at minimal costs," he notes.

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Research Article

Funding:

This study was funded by a UK Medical Research Council Population Health Scientist Fellowship awarded to JLB – Grant Ref: MR/L011891/1, https://www.mrc.ac.uk/. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America

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